Healthcare Provider Details

I. General information

NPI: 1043335656
Provider Name (Legal Business Name): JEAN ALLYN DHORITY CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 VERDOS DR
ELIZABETH CO
80107-8547
US

IV. Provider business mailing address

555 VERDOS DR
ELIZABETH CO
80107-8547
US

V. Phone/Fax

Practice location:
  • Phone: 303-646-1350
  • Fax: 303-646-1356
Mailing address:
  • Phone: 303-646-1350
  • Fax: 303-646-1356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number3511257
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: